Lg220A Form PDF Details

Are you in need of a Lg220A form to process your benefit application? If so, you’re in the right place! In this post, we will discuss all the information necessary for properly filling and submitting your Lg220A form. We'll cover topics such as who needs a completed version of this form, where it can be found and how it should be filled out correctly. With these tips and resources on hand, you will have all that's required for successfully filing your paperwork with the government agency responsible for handling benefits applications! Let's dive into what exactly is an Lg220A and everything else you need to know about this important document.

QuestionAnswer
Form NameLg220A Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesceo, subd, roseville, lg220a exempt permit financial reporting form

Form Preview Example

MINNESOTA LAWFUL GAMBLING

8/18

 

LG220A Exempt Permit Financial Report

By state law, organizations that received an exempt permit (using the LG220 application form) are required to submit a financial report within 30 days of each gambling occasion (Minn. Statutes, section 349.166, subd. 2(a)(6)).

Complete the information below. Email, fax or mail to the Gambling Control Board within 30 days of the gambling activity date.

Your organization must keep all exempt raffle records and reports for 3-1/2 years (Minn. Statutes, section 349.166, subd. 2(f)).

ORGANIZATION INFORMATION

Organization Name: ________________________________________________________________________________________

Mailing Address: ____________________________________ City: ______________________ State: _____ Zip: ____________

Activity Dates: _____________________ to _____________________ Exempt Permit Number X_____________________

FINANCIAL REPORT

Activity conducted

 

Expenses, including

Net profit

Gross receipts

cost of purchased and

(subtract expenses

for each activity

cash prizes

from gross receipts)

Total Value of Prizes

-Purchased (full retail value even if discounted)

-Donated (full retail value)

-Cash (total face value of dollars awarded)

Bingo

Raffle

Paddlewheel

Tipboard

Pull-Tabs

DISTRIBUTOR INFORMATION

If paddlewheels, tipboards, or pull-tabs are conducted, list the licensed distributor from whom the gambling equipment was purchased.

Distributor: ___________________________________________________ Date of Purchase: ____________________________

ACKNOWLEDGMENT OF CHIEF EXECUTIVE OFFICER (CEO)

I declare that all financial information is true, accurate, and complete.

Print Name of Current CEO: __________________________________________________ Phone: _________________________

Signature of Current CEO: ___________________________________________________ Date Signed: ____________________

Email: ___________________________________________________________________________________________________

MAIL OR FAX TO:

Minnesota Gambling Control Board

1711 W County Road B, Suite 300 South

Roseville, MN 55113

EMAIL: gcb.financialreports@state.mn.us

FAX: 651-639-4032

DATA PRIVACY NOTICE:

The information on this form and any attachments will become public information when received by the Board and will be used to determine your compliance with Minnesota statutes and rules governing lawful gambling activities.

Questions? Contact the Licensing Specialist assigned to your county by calling 651-539-1900.

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Tips on how to fill in lg220a part 1

2. Once your current task is complete, take the next step – fill out all of these fields - If paddlewheels tipboards or, Distributor Date of Purchase, ACKNOWLEDGMENT OF CHIEF EXECUTIVE, I declare that all financial, Print Name of Current CEO Phone, Signature of Current CEO Date, Email, MAIL OR FAX TO, Minnesota Gambling Control Board, EMAIL gcbfinancialreportsstatemnus, DATA PRIVACY NOTICE The, and Questions Contact the Licensing with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Writing section 2 in lg220a

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